| NPI | 1922094804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0006296) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH233952) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2017-01-14 |